13
6.5. Heart Rhythm Assessment
COR LOE
Recommendations
1 B-NR
1. In patients with HCM, a 12-lead ECG is recommended in
the initial evaluation and as part of periodic follow-up (every
1 to 2 years) (Figure 1, Table 6).
1 B-NR
2. In patients with HCM, 24- to 48-hour ambulatory
electrocardiographic monitoring is recommended in the
initial evaluation and as part of periodic follow-up (every 1
to 2 years) to identify patients who are at risk for SCD and to
guide management of arrhythmias (Figure 1).
1 B-NR
3. In patients with HCM who develop palpitations or
lightheadedness, extended (>24 hours) electrocardiographic
monitoring or event recording is recommended for
arrhythmia diagnosis and clinical correlation.
1 B-NR
4. In first-degree relatives of patients with HCM, a 12-lead
ECG is recommended as a component of the screening
algorithm (Figure 1, Table 6).
1 B-NR
5. In patients with HCM who are deemed to be at high risk
for developing AF based on the presence of risk factors or
as determined by a validated risk score, and who are eligible
for anticoagulation, extended ambulatory monitoring is
recommended to screen for AF as part of initial evaluation
and annual follow-up (Figure 1).
2b B-NR
6. In adult patients with HCM without risk factors for AF and
who are eligible for anticoagulation, extended ambulatory
monitoring may be considered to assess for asymptomatic
paroxysmal AF as part of initial evaluation and periodic
follow-up (every 1 to 2 years).
6.6. Angiography and Invasive Hemodynamic Assessment
COR LOE
Recommendations
1 B-NR
1. For patients with symptomatic HCM for whom there is
uncertainty regarding the presence or severity of LVOTO
on noninvasive imaging studies, invasive hemodynamic
assessment with cardiac catheterization is recommended.
1 B-NR
2. In patients with HCM who have symptoms or evidence of
myocardial ischemia, coronary angiography (CT or invasive)
is recommended.
1 B-NR
3. In patients with HCM who are at risk of coronary
atherosclerosis, coronary angiography (CT or invasive) is
recommended before surgical myectomy.
